1. The patient

With all the stress on informed consent in health care, it is not surprising that the first priority is generally given to the patient's wishes.

If the patient refuses treatment, you might think that would settle the matter.

But it doesn't - not quite.

• suppose the patient is 3 years old
• suppose the patient is in the advanced stages of alzheimer's disease
• suppose you have reason to think the patient is reacting from a temporary depression that will clear up in a short while

Should we honor the patient's wishes in these situations?

Most folks would say that these are legitimate exceptions to the principle of patient choice.

Advance Directives are mechanisms by which patients can make their wishes known before they lose the capacity to express them, so they may influence decisions indirectly even when they are no longer capable of making the decisions themselves.

Created by Glenn C. Graber - last updated March 8, 2003
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